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ICD-10 Guide
ICD-10 CodesH11.033

H11.033

Billable

Double pterygium of eye, bilateral

BILLABLE STATUSYes
IMPLEMENTATION DATEOctober 1, 2015
LAST UPDATED09/06/2025

Code Description

ICD-10 H11.033 is a billable code used to indicate a diagnosis of double pterygium of eye, bilateral.

Key Diagnostic Point:

Double pterygium of the eye, bilateral, is characterized by the presence of two pterygia on each eye, which are triangular-shaped growths of conjunctival tissue that extend onto the cornea. Clinically, patients may present with symptoms such as irritation, redness, and visual disturbances due to the encroachment of the pterygium on the corneal surface. The anatomy involved includes the conjunctiva, sclera, and cornea, with the pterygium affecting the anterior segment of the eye. Disease progression can lead to increased astigmatism and potential vision impairment if left untreated. Diagnostic considerations include a thorough ocular examination, where the growths can be observed, and possibly imaging studies to assess the extent of corneal involvement. Differential diagnoses may include other conjunctival lesions, such as conjunctival cysts or neoplasms, which must be ruled out to confirm the diagnosis of bilateral double pterygium.

Code Complexity Analysis

Complexity Rating: Medium

Medium Complexity

Complexity Factors

  • Diagnostic complexity: Requires careful examination and differentiation from other conjunctival disorders.
  • Treatment complexity: May involve surgical intervention, which requires pre-operative assessment and post-operative care.
  • Documentation requirements: Detailed clinical notes are necessary to support the diagnosis and treatment plan.
  • Coding specificity: Requires precise coding to differentiate between unilateral and bilateral conditions.

Audit Risk Factors

  • Common coding errors: Misidentifying the condition as unilateral or failing to document bilateral involvement.
  • Documentation gaps: Incomplete clinical notes that do not adequately describe the severity or impact of the pterygium.
  • Billing challenges: Potential for denials if the medical necessity for surgery is not clearly documented.

Specialty Focus

Medical Specialties

Ophthalmology

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Optometry

Documentation Requirements

Standard ICD-10-CM documentation requirements apply

Common Clinical Scenarios

Various clinical presentations within this specialty area

Billing Considerations

Follow specialty-specific billing guidelines

Related ICD-10 Codes

Related CPT Codes

CPT Code

Clinical Scenario

Documentation Requirements

CPT Code

Clinical Scenario

Documentation Requirements

ICD-10 Impact

Diagnostic & Documentation Impact

Enhanced Specificity

ICD-10 Improvements

The clinical significance of H11.033 lies in its potential to affect visual acuity and quality of life for patients. Pterygium is more prevalent in populations exposed to UV light, making it a public health concern in certain geographic areas. Understanding the epidemiology of pterygium can help healthcare providers implement preventive measures and improve patient outcomes through timely intervention.

ICD-9 vs ICD-10

The clinical significance of H11.033 lies in its potential to affect visual acuity and quality of life for patients. Pterygium is more prevalent in populations exposed to UV light, making it a public health concern in certain geographic areas. Understanding the epidemiology of pterygium can help healthcare providers implement preventive measures and improve patient outcomes through timely intervention.

Reimbursement & Billing Impact

Reimbursement considerations may vary based on the payer, and coders should be aware of specific guidelines for pterygium surgery. Common denials may arise from insufficient documentation or failure to demonstrate the impact of the pterygium on vision. Best practices include maintaining thorough clinical notes and ensuring that all relevant details are captured in the patient's medical record.

Resources

Clinical References

  • •
    ICD-10 Official Guidelines for H00-H99
  • •
    Clinical Documentation Requirements

Coding & Billing References

  • •
    ICD-10 Official Guidelines for H00-H99
  • •
    Clinical Documentation Requirements

Frequently Asked Questions

What specific conditions are covered by H11.033?

H11.033 specifically covers bilateral double pterygium, which involves two pterygia on each eye. It is important to differentiate this from unilateral pterygium codes, as well as other conjunctival growths.

When should H11.033 be used instead of related codes?

H11.033 should be used when both eyes are affected by double pterygium. If only one eye is affected, the appropriate unilateral code should be selected. Accurate documentation of bilateral involvement is crucial.

What documentation supports H11.033?

Documentation should include a detailed ocular examination report, noting the presence and extent of pterygia in both eyes, patient symptoms, and any visual impairment. Surgical notes should also reflect the bilateral nature of the condition if surgery is performed.